Health Indicators: A Review of Reports Currently in Use

Transcription

1 Health Indicators: A Review of Reports Currently in Use Prepared for The State of the USA By Cheryl Wold, MPH Wold and Associates Consulting Presentation July 21, 2008

2 My Background

3 Today s s presentation Provide quick overview of the contents of the report. Highlight some important themes for indicators of health in the U.S. Discussion.

4 Background Stated aim of SUSA to engage customers with neutral and high-quality data. Requires well-vetted indicators and effective framing and communication. Committee s s work will benefit from decades of health indicators work at the national and local, and international level.

5 Methods Conceptual models: Broad health determinants (Figure 1); Social health determinants (Figure 2); Life course/health development - early life focus (Figures 3 and 4); Health system performance (Figures 5 and 6); Supplemented conceptual approaches with international reports and those with an emphasis on heath equity and quality of life.

6 Methods Indicator sets covering a broad spectrum of health and health system domains. Reports generated by reputable individuals and processes using high- quality data and measures. Reports using innovative approaches to framing and communicating indicators. Convergence and breadth.

7 Overview of Results Table 1 describes 35 reports and key features. General health national, state, local levels (14); Quality of life/comprehensive indicator reports (5) at any level (i.e., local-international); Health system performance, focus on access, cost, quality (11); Other reports, focus on gaps, communication approaches (5).

8 Overview of Results (continued) Tables 2 and 3 show selected indicators from general health reports. Table 4 shows selected data sources for general health indicators. Tables 5, 6, and 7 show indicators for health system performance,, featuring indicators of access, cost, and quality. Table 8 shows data sources for health system performance indicators.

9 Overview of Results (continued) Section 4 includes a summary of each report; tables (exhibits) showing indicator sets used in each report. Figures are found in Section 5. References and Appendix A link to information about data and measurement capabilities. Appendix B provides more extensive measures and data sources, but for a limited sample of 5 reports.

10 Highlights - Indicators General health indicators: Overlap: Mortality (life expectancy, cause-specific specific rates, premature death), birth (infant mortality, low birth weight), chronic diseases (heart disease, cancer, diabetes), major risks (e.g., obesity, smoking), health related quality of life (poor health days, self-rated health); health insurance, receipt of health services (e.g., immunization, cancer screening). Divergence: emphasis on social indicators (education, living conditions in family and community, economic conditions), early life indicators, and health care (dental, prenatal care, screenings and exams), mental health, alcohol and drug use, disability, opportunities for primary prevention, equity, disparities.

11 Highlights Indicators Health system performance - Access: Overlap: Health insurance coverage, regular source of care, access barriers, delays in receipt of care. Divergence: Market trends, structure of the health care delivery, trends in employer- sponsored health coverage, mental health/alcohol and drug treatment, linguistic isolation, health literacy, differential utilization (e.g., prescription drugs, preventable hospital admission).

12 Highlights Indicators HSP - Cost/Efficiency of Care: Overlap: Health care spending (total and per capita) avoidable hospitalizations and care (e.g., ambulatory care sensitive), cost of premiums. Divergence: Avoidable care (supply sensitive, ICU at end of life, readmissions), health care resource inputs (human, facilities, physician visits), out-of of-pocket costs, care intensity in last two years, hospital cost efficiency, resource use intensity.

13 Highlights Indicators of Health system performance Quality/Effective Care/Patient Safety: Overlap: Breast cancer screening, survival; Vaccinations; AMI acute and 30-day mortality; asthma management and mortality. Other measures mostly diverge (by design), e.g., adoption of patient safety measures by states; processes of care that are problematic for patient safety/harm and poor quality; consumer experiences with care as proxies for quality (e.g., experience with hospital stays).

14 Communication Themes from reports: v Increasing health care costs (from consumer, employer, and fiscal perspectives). Growth in spending on health care fiscal instability, growth in spending not sustainable, loss of coverage, out-of of- pocket costs. v Levels of health, quality, outcomes, and equity are not consistent with level of spending; Health improvement. v Increasing concern and evidence about social factors and health; these contribute to multiple poor outcomes and inequities. v Broad acknowledgement of need for multi-sector approaches.

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16 What Drives Health? RWJ Commission to Build a Healthier America Three Health Conditions: Infant and child health Obesity Adult chronic disease Social Factors: Early life experience, education, income, work, housing, community, race/ethnicity and the economy.

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18 Presentation of Indicators Varied analytic and presentation approaches.

19 Lung cancer mortality relative to Healthy People 2010 targets in 54 largest cities in the U.S.

20 Grades for mortality and unhealthy days among working age adults. Separate comparisons of rates as compared to averages for other states. Disparities grade.

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25 Gaps (noted in report) Indicators/data sources devoted to early childhood well-being and investments in early childhood health and development. Physical environmental factors. Efficiency in health care.

26 Gaps (not noted in report) Indicators of emergency preparedness for natural and intentional disasters, epidemics, and attacks. Few indicators related to the business case for health and workplace wellness. Few indicators related to investments or spending in sectors other than medical care. For example, investments in young children, or in health research. Policies indicators of state/federal health policy development or implementation.

27 Thank you and GOOD LUCK! Questions or comments

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